LUNG CARCINOMA (BRONCHIAL CARCINOMA) By: Dr Waqar MBBS, MRCP Asst. Professor of Medicine

Carcinoma (cancer) in the lungs can be primary ( arising from the lung) or secondary (metastasis from another site) Today we will discuss primary lung cancer.

TYPES OF LUNG CARCINOMA Small cell lung Ca. Non-Small cell lung Ca. ( SCLC) (NSCLC) AdenoCa. Squamous cell Ca. Large cell Ca. This classification is based on histology 85% cases of Ca. lung are NSLC ( adeno. & Squamous) ( how to remember: NSC ( 3 letters) 3 types

ETIOLOGY I AM SURE YOU ALL KNOW THE MOST COMMON CAUSE OF LUNG CANCER !

Etiology contd. Cigarette smoking: 85% of cases are due to smoking “Passive” smoking also increases the risk of lung cancer. 20-30% increased risk to get lung cancer if someone at home smokes & u inhale that smoke. 2) Radon Gas: This is produced by breakdown of uranium in earth’s crust. * Long term exposure to radon can cause Ca. lung * Second commonest cause in USA

Etiology contd 3) Asbestos:(A natural material used in building) Asbestos exposure can cause Ca. lung and some other lung diseases. 4) Genetics: In some patients, it is due to some genetic defect 5) Increased risk of lung cancer in COPD & Idiopathic Pulmonary Fibrosis(IPF) patients.

Signs & Symptoms Respiratory Symptoms: * Cough wth sputum * Hemoptysis * Dyspnea & wheezing * Chest pain (if tumor spreads to chest wall) 2) Systemic S/S : * Wt. loss * Fever * Weakness * Clubbing Above are the most common presenting symptoms. 3) Chest Examination: It may show signs of collapse, consolidation or pleural effusion( tumor can spread to the pleura & cause effusion)

COMPLICATIONS Ca lung can cause some complications which can also be the presenting signs & symptoms. Compressive symptoms Pneumonia Brachial plexus damage/Horner’s syndrome Hoarseness Para-neoplastic syndromes Pleural effusion : due to metastases to the pleura.

COMPLICATIONS Compressive S/S: * Dysphagia ( due to esophageal compression) * Face & neck edema( due to superior vena cava obstruction) 2) Pneumonia: Tumor mass obstructs the airway pooling of secretions superimposed infection 3) Brachial plexus damage /Horner’s synd. * Occurs if cancer is in the apex of the lung ( Pan- -coast’s tumor) * Causes pain & other neuro. features in the arm * Horner’s : Ptosis + meiosis + anhydrosis on forehead 4) Hoarseness of voice ( involvement of recurrent laryngeal nerve)

Cancer in lung apex (Pancoast’s tumour)

Obstruction of Superior vena cava

Complications contd. 5) Paraneoplastic Syndromes: ( more in SCLC) * These are S/S not due to local spread of tumor but due to hormones or other factors produced by the tumor. a) Excess ADH production (SIADH) b) Excess ACTH production Cushing’s (? Disease or syndrome? ) c) Eaton-Lambert syndrome: A disease resembling resembling myasthenia gravis. d) Hypercalcemia: due to excess production of a hormone called PTHrp (PTH related peptide) e) Cerebellar degeneration f) Myopathy ( muscle weakness)

SOME POINTS Adenocarcinoma: * Most common type of lung cancer * Located in the outer part of the lung 2) Squamous cell Ca. : Located in the central area, close to the main bronchus. 3) Small cell lung cancer is more aggressive and grows very fast. At the time of diagnosis, it is widely spread ( metastasis), so very poor prognosis.

METASTASIS Lung carcinoma can metastasize to : Brain : causing neurological S/S (siezures etc) Bone: causing bone pain & fractures Liver Adrenals Pleura : Causing pleural effusion

DIAGNOSIS Person with a history of smoking and having cough, hemoptysis, wt. loss etc, should always be investigated for carcinoma. Chest X-Ray: This is the 1st thing to do. It may show a mass, solitary nodule, wide mediastinum due to nodal spread, pleural effusion, lung collapse of the affected area etc. A NORMAL X-RAY DOES NOT RULE OUT LUNG CA.

X-RAYS OF LUNG CANCER Peripheral mass (? Adenocarcinoma) Peripheral tumor ( ?adenoca.)

Central mass (?squamous cell)

Ca. ( wth pleural effusion) Ca. with wide mediastinum

Investigations contd. 2) C.T. Chest: It gives more details of the mass 3) Sputum cytology: Sputum may show malignant cells 4) Biopsy: This is the definitive test for diagnosis. *For centrally located masses, bronchoscopy is done & biopsy of the mass is taken. *For peripheral lesions, biopsy through the chest wall (with CT guidance) is done.

STAGING Staging of the tumor is done based on the investigations. It tells how far the cancer has spread. Stage 1: Cancer is located only in the lungs & has has not spread to any lymph nodes. Stage 2: Cancer is in the lungs & the nearby nodes Stage 3:Cancer is found in the lungs & in the nodes in the middle of the chest. This stage is further divided into stage 3 A & B Stage 4: Cancer has spread to both lungs, pleura or distant metastases.

TREATMENT The three main types of treatment modalities are: Surgery Radiotherapy Chemotherapy Which type of treatment to choose? Depends on the type of lung cancer & its stage

Treatment (contd) NSCLC: a) Stage 1 &2 : Surgery b) Stage 3 : Radiotherapy + chemo. c) Stage 4 : Chemo. Chemo drugs: Cisplatin & carboplatin SCLC: Mainly chemo. Surgery can not be done coz it is very widely spread by the time it is diagnosed.

PROGNOSIS Overall prognosis is poor. The 5 year survival rate is only 10-15%. SCREENING It is now recommended to screen all smokers for lung cancer, by a C.T. chest every year (low dose CT).

THANK YOU READY FOR A JOKE?